|
K WIRE 2.4 MM X 170 MM
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
270685919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
K WIRE 2.4 MM X 170 MM
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
270685919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Medicare Advantage |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.12
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.50
|
| Rate for Payer: Oxford Commercial |
$15.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.99
|
|
|
K-WIRE 2.5
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270686219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
K-WIRE 2.5
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270686219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
K-WIRE 2.5MM THREAD TIP
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
270656778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
K-WIRE 2.5MM THREAD TIP
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
270656778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare Advantage |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.50
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
K-WIRE 2.5mm X 200mm
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270637467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.50
|
| Rate for Payer: Oxford Commercial |
$35.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.64
|
|
|
K-WIRE 2.5mm X 200mm
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270637467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
K-WIRE 2.5x150MM
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270674309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.50
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.05
|
|
|
K-WIRE 2.5x150MM
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270674309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
K-WIRE 2.5X200MM
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
K-WIRE 2.5X200MM
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
KWIRE 2.5x270mm
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270683635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
KWIRE 2.5x270mm
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270683635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
K-WIRE 2.5x270MM
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
270656781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
K-WIRE 2.5x270MM
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
270656781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare Advantage |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.50
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
K-WIRE 2MM
|
Facility
|
IP
|
$154.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$34.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
|
|
K-WIRE 2MM
|
Facility
|
OP
|
$154.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Commercial |
$58.79
|
| Rate for Payer: Aetna Medicare Advantage |
$46.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.45
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$34.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.10
|
|
|
K-WIRE 2mm KW2.0
|
Facility
|
IP
|
$84.40
|
|
| Hospital Charge Code |
270634967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.66
|
|
|
K-WIRE 2mm KW2.0
|
Facility
|
OP
|
$84.40
|
|
| Hospital Charge Code |
270634967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$32.07
|
| Rate for Payer: Aetna Medicare Advantage |
$25.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.52
|
| Rate for Payer: Cigna Commercial |
$42.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.32
|
| Rate for Payer: Oxford Commercial |
$16.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.24
|
|
|
KWIRE 2MMX450MM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$185.44
|
| Rate for Payer: Aetna Medicare Advantage |
$146.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.44
|
| Rate for Payer: Cigna Commercial |
$244.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$107.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.93
|
|
|
KWIRE 2MMX450MM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$118.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$107.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.20
|
|
|
K-WIRE 2X150MM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$27.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
K-WIRE 2X150MM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$27.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
K-WIRE 2 X TROCAR 1.1x100MM
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270675272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.00
|
| Rate for Payer: Oxford Commercial |
$42.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.57
|
|